Division of Gastroenterology and Hepatology, Liver Research Institute.
Center for Population Science and Discovery, University of Arizona, Tucson.
Am J Med. 2018 Jul;131(7):728-734. doi: 10.1016/j.amjmed.2018.01.047. Epub 2018 Feb 26.
Liver disease is an important cause of morbidity and mortality in the United States. Geographic variations in the burden of chronic liver disease may have significant impact on public health policies but have not been explored at the national level. The objective of this study is to examine interstate variability in liver disease mortality in the United States.
We compared liver disease mortality from the 2010 National Vital Statistics Report on a state level. States in each quartile of liver disease mortality were compared with regard to viral hepatitis death rates, alcohol consumption, obesity, ethnic and racial composition, and household income. Race, ethnicity, and median household income data were derived from the 2010 US Census. Alcohol consumption and obesity data were obtained from the 2010 Behavioral Risk Factor Surveillance System Survey.
We found significant interstate variability in liver disease mortality, ranging from 6.4 to 17.0 per 100,000. The South and the West carry some of the highest rates of liver disease mortality. In addition to viral hepatitis death rates, there is a strong correlation between higher percentage of Hispanic population and a state's liver disease mortality rate (r = 0.538, P < .001). Lower household income (r = 0.405, P = .003) was also associated with the higher liver disease mortality. While there was a trend between higher obesity rates and higher liver disease mortality, the correlation was not strong and there was no clear association between alcohol consumption and liver disease mortality rates.
肝脏疾病是美国发病率和死亡率的重要原因。慢性肝脏疾病负担的地域差异可能对公共卫生政策产生重大影响，但尚未在国家层面进行探讨。本研究的目的是研究美国肝脏疾病死亡率的州际差异。
我们比较了 2010 年国家生命统计报告中按州划分的肝脏疾病死亡率。将肝脏疾病死亡率处于每个四分位区间的各州进行比较，比较指标包括病毒性肝炎死亡率、酒精消费、肥胖、种族和民族构成以及家庭收入。种族、民族和家庭收入中位数数据来自 2010 年美国人口普查。酒精消费和肥胖数据来自 2010 年行为风险因素监测系统调查。
我们发现肝脏疾病死亡率存在显著的州际差异，范围从每 100,000 人 6.4 到 17.0 人不等。南部和西部的肝脏疾病死亡率最高。除了病毒性肝炎死亡率之外，西班牙裔人口比例较高与州肝脏疾病死亡率之间存在很强的相关性（r=0.538，P<0.001）。较低的家庭收入（r=0.405，P=0.003）也与较高的肝脏疾病死亡率相关。尽管肥胖率与较高的肝脏疾病死亡率之间存在趋势，但相关性不强，且酒精消费与肝脏疾病死亡率之间没有明确的关联。
